MSIA: Things I should have said...

Written by Dr Geoffrey Sayer on 21 November 2011.

I wish I had kept a diary for the past two years during my time as the Medical Software Industry Association President (MSIA). The things I have seen, heard and read have generated all sorts of emotional responses: surprise; laughter; disappointment; frustration; sadness; anger; and humility. Health at the best of times is a hot topic. Throw an “e” at the start of Health and all sorts of “emotional” responses are brought forward. Throughout this roller-coaster ride of ups and downs, where often you only have a narrow window to get a point across, there are a number of things that, with the benefit of hindsight, I wish I had said.

The current politicians’ need both better advisors and to make public servants actually responsible for their actions if they want to progress change. The political process is a short-term cycle and the objective seems to be simply to stay in power. We should accept this as a fact of how politics works. It is not as complicated as they would want us to believe. More time (and money it seems), is spent on spin doctoring rather than calling to account the people or organisations that money is provided to.

I was fortunate enough, I think, to meet senior politicians. It seems to me they are incredibly busy and are incredibly nice when dealing with the punters. I was told by a cynic they are paid to be nice and it is not genuine, but I will give those I met the benefit of the doubt. They are good at appearing genuinely concerned about your issues. But I have come to the conclusion they really are being let down by the people who are supposed to be implementing the policies they announce. If one examines the senior ranks of the public service, many have been there for many years. They are career public servants. The same people generally working under different political ethos. Given the public servants are stable over time, why can’t we get sustainable change across different governments? The focus seems, at certain levels in the hierarchy of the public service, to be to stay out of the paper for the wrong reasons. I have come to the conclusion that the public servants fear the media more than the politicians. It is the media that creates accountability in a transient way instead of instituted accountable processes as part of funding models or effective political processes.

In the political process there are accountability processes. Two of these processes were the Senate Enquiry and the Senate Estimates. The Senate Enquiry for the Health Identifiers legislation was a new experience for me. The signing of the paperwork before appearing was extremely serious as deliberate misrepresentation carries penalties, and rightfully so. At the time, industry was at logger-heads with anyone who crossed our path, and we had profile regarding patient safety and the proposed implementation plans.

On the way down to Canberra in the car with my MSIA colleague we were being lobbied — the only way I could describe it — by all sorts of people to be on our best behaviour and present a positive industry position at our representation. That was not hard to do as industry had a clear message — we wanted the Health Identifiers, and it was the one thing that we all thought would be good for the eHealth agenda.

What was strange was the performance of others who were not very clear in their responses when they should have been. The accountability was also inconsistent on the Senator’s side. A Senator lounged around in his chair asking each speaker their thoughts on benefits versus risk in a haphazard manner rather than one of meticulous consideration. It seemed he wasn’t as learned as he made out, or at least was convincing us that he wasn’t, but was afforded the luxury of keeping account for this important piece of legislation. I thought that day I could make a great Senator. I could slouch around, duck in and out for apparently more important things and ask random, ill-formed questions as well as anyone. Basically be difficult without being helpful. I wish I had said “Can I get paid for what you do too?”.

Looking at the Senate Estimates process, the level of drilling down appears limited, and the Senators appear to have different levels of performance depending on the level of briefing or advice they have been given. eHealth can be complicated and detailed, but if one is serious about $467 million, then one should make an effort to apply $467 million of accountability to the equation. The fact that it commands so little time on the Senate Estimates agenda indicates to this untrained eye that it is not really taken seriously, and there are more pressing issues requiring accountability.

I find it odd that governments deal in millions and billions of dollars, but at times really don’t seem to care about how the money is being used when deciding how that money will be spent. One of my business mentors taught me early to spend money as if it is actually yours. The idea is you value your own money more than someone else’s. While it did encourage me to spend wisely, I actually feel more responsibility when it is someone else’s money, and have tried to always be frugal and get the most out of money, whether it be research grants, budgetary figures, tax payers, or company money.

I think we lose accountability when we are not paying for clear outcomes. The accountability for public money is too much after the fact with Auditor General reports. Why isn’t there built-in accountability as we go along with public money? Real ‘lessons learnt’ as we go along. Why do governments try to distance themselves from keeping a timely, closer, accountable and transparent view of how public money is spent? I wish I had said that to the many politicians I have met in the past two years.

In the world of business, if I was a share holder in a company and I contributed 50% of the capital, I would take a vested interest in how that money was being spent. I would want know how that company was going against the stated goals and the business plan of activities. I would want to have my interests represented well in the form of directorship/s, and would also want to have a big say in who the Chair of the Board was as well. I would expect the board would call to account management of the company in terms of their performance. While the Chair and directors would need to ensure they complied with appropriate board-type responsibilities through the year, when it came to the AGM I would be using my vote to show my appreciation by continued support or disdain by having them removed, or asking why individuals in the senior management in charge of delivering the business objectives had not been removed. I am perplexed why that has not happened with companies regardless of whether they are ‘for profit’ or ‘not for profit’. I am also perplexed by the adage that “people are working really hard” so I should be appreciative. I thought in any organisation it was about results — short term and sustainable asset growing activities. While I am sure shareholders like to hear people are working hard, they actually like to know what results they are getting. It is what shareholder value or outcomes have been delivered that matters. I wish I had a said to one Chair: “If Kerry Packer had given your organisation $150 million, given the results, would you still be Chair of this organisation?” I could have followed up with: “Would the CEO still be the CEO?”

It is what happens next that really matters. We have all had experiences in our past that we would like to forget. While there are things that I should have said, I am sure there are things I should not have. Despite the frenetic pace that the eHealth agenda is facing and its potential derailment in many eyes, it is not too late to look at what can be achieved if we effectively work together to deliver the building blocks of eHealth. It is still possible if we harness the good will and the money that has been allocated to the eHealth agenda. Industry can help if they are helped. It has to be a constructive and effective action-generating outcomes. It is a hard task before us at best, so let us not make it harder than it already is. Simple, simple, simple steps is all that is needed. These steps will have lasting effects and stimulate innovation and creativity in the market place.

In conclusion: “Where is the rest of the $467 million that is not accounted for?” Any simple calculation of announced funding seems to have $10’s of millions, if not a lazy $100 million, unaccounted for. Why can’t that money be used to assist industry broadly to get the foundation pieces in place, like Health Identifiers, terminology and secure messaging across all sectors? This will deliver greater benefits and improve the effectiveness and efficiency in health and healthcare delivery than a Personally Controlled Electronic Health Record (PCEHR) system alone. Furthermore, it will enhance the PCEHRs that are already in existence and support the uptake of existing ones. This will be a lost opportunity if this money is not wisely spent with the broader industry to bring them to the table to deliver change. If we don’t engage the wider industry now, they will wander off and pursue things that really matter. eHealth dreams will be remembered as lost opportunities, good money after bad again, like the ghosts of eHealth past.

Geoffrey is Head of Operations, HealthLink. He has spent the past 20 years working as an epidemiologist. For the past 10 years Geoffrey has occupied senior management positions in medical software companies.